Dr. Apgar didn't set out to be an anesthesiologist. After graduating fourth in the P&AMP;S Class of 1933, Dr. Apgar was determined to be a surgeon, and she began a surgical internship at Presbyterian Hospital. But Dr. Alan Whipple, chairman of surgery, discouraged her from continuing in surgery, according to Dr. Selma Harrison Calmes in a report prepared for the 1982 meeting of the American Association for the History of Medicine. The discouragement stemmed from the disappointing experience of three of the four other women surgeons Dr. Whipple had trained and an overcrowding of the field, leading him to believe she could not be financially successful as a surgeon.
After her surgical internship, Dr. Apgar started work at Columbia-Presbyterian with a nurse anesthetist before spending time at the University of Wisconsin in the nation's first department of anesthesia.
Back at Columbia-Presbyterian in 1938, she started building a division of anesthesia within the Department of Surgery, a division that later became the Department of Anesthesiology. Under her leadership, anesthesia was taught to medical students, a residency program was initiated, the use of nurse anesthetists was phased out, research was conducted, and anesthesiology as a field was advanced through use of various agents and techniques that became available. In devoting her expertise and research to obstetrical anesthesia and developing the Apgar score, Dr. Apgar is said to have laid the cornerstone of the new science called perinatology.
While devoting her energy to obstetric anesthesia, Dr. Apgar developed the famous Apgar Score. According to the report by Dr. Calmes, the idea for the score was born in 1949, when the Columbia anesthesiologists were eating breakfast together and a student asked about the need to evaluate the newborn. Dr. Apgar grabbed the nearest piece of paper-a "Please bus your own trays" sign-and wrote down the five points that became the score. The score was presented at a meeting in 1952 and published in 1953.
Dr. Apgar, working with Dr. James, a pediatrician, and Dr. Duncan Holaday, an anesthesiologist-researcher, strengthened the value of the Apgar score, and the three published a second report (in 1958) on the score's use in evaluating a newborn infant.